Management of non-retroperitoneal residual germ cell tumor masses.

The appropriate management of residual disease outside of the retroperitoneum after chemotherapy is a critical component of the comprehensive approach to treating advanced testicular germ cell tumors (GCTs). Although some data suggest that certain variables (eg, histology at retroperitoneal lymph node dissection) can accurately predict non-retroperitoneal histology, a multitude of studies demonstrate significant histologic discordance among different sites. In patients who have normalized serum tumor markers, therefore, we recommend resection of all sites of residual disease outside of the retroperitoneum. After excision of residual viable GCT, evidence suggests that at least intermediate-risk patients who have received only induction chemotherapy benefit from further systemic treatment.